DOLE/BWC/IP-3 Series of ________

Application No. ____________

Republic of the Philippines Department of Labor & Employment

Regional Office No. __________

APPLICATION FOR: REGISTRATION

RE- REGISTRATION

__________________________
Date

1. Name of Establishment _________________________________________________________________________________________

2. Address: _____________________________________________________________________________________________________
Street City/Municipality Province
3. Name of Manager/Owner: _______________________________________________________________________________________
4. Address of Manager/Owner: _____________________________________________________________________________________
5. Nature of Business & Product Manufactured, Service Rendered or Merchandise sold:
(Example Manufacturing --- Textile; Construction --- Building; Agriculture --- Production of Livestock, etc.; Forestry --- ; Logging; Services
--- Generation and Distribution of Electricity; Commerce --- Lumber and Construction Materials; Wholesale or Retail)
_______________________________________________________________________________________
_______________________________________________________________________________________
6. Number of Employees: GRAND TOTAL _____________________

Filipinos Resident Alien Non-Resident Alien Minors

Below 15 Below 18
Male
Female
Total

7. Name and Address of Labor Union, if any: _____________________________________________________________________________

BIR Registration No. ________________________
8. Technical Information:
a. Machinery, Equipment and other Devices in Use: (Example: Machinery Drill press, Circular Saw etc. Boiler; Pressure
Vessel; Internal Combustion Engine --- Diesel, Gasoline _______________________________________________________________
___________________________________________________________________________________________________________
b. Materials Handling Equipment and Devices: Example; Handtrucks, Power Trucks, Conveyors, etc.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
c. Chemicals or substances used or handled:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
9. If branch unit, name of parent establishment: :
Location _______________________________________________________________________________________________________
10. Current Capitalization P __________________________________ Total Assets: ___________________________________

FOR RE-REGISTRATION ACCOMPLISH ALSO:

1. Past Application Number _______________________________ Date of Application ___________________________________

2. If Changing Name of Establishment, State Former Name: ________________________________________________________________
3. If Changing Location, Give Past Address: _____________________________________________________________________________
4. Layout Plan, Floor by Floor in scale 1:100 (attached to this application)

I hereby certify that the above information is true and correct.

RECEIVED AND APPROVED

____________ Date ______________

Enforcing Officer

_____________________________________ _____________________________________
Director Owner/Manager

TIN _______________________